Diisocyanate terminated macromer and formulation thereof for use as an internal adhesive or sealant

ABSTRACT

A novel macromer or mixture thereof is described herein, comprising benzoyl isocyanate terminal moieties and at least two residues of a water-soluble polymer having a molecular weight ranging from 80 to 10,000 adjacent to the carbonyl group of the benzoyl isocyanate moieties, thereby forming at least two ester linkages in the macromer or mixture thereof. A method for making a polyisocyanate macromer is also described herein.

RELATED APPLICATION

This application is a continuation-in-part application of U.S.application Ser. No. 11/333,057, filed on Jan. 17, 2006 and U.S.application Ser. No. 11/032,332, filed on Jan. 10, 2005.

FIELD OF THE INVENTION

Described herein are novel polyisocyanate macromers or mixture thereofand the use thereof to form an internal adhesive or sealant for use incardiovascular, peripheral-vascular, cardio-thoracic, gynecological,neuro- and general abdominal surgeries. More particularly, the macromersor mixture thereof or a formulation thereof polymerizes in the humanbody to form an elastic gel that is biocompatible and that degrades intoproducts that are non-toxic and biocompatible. Additionally, thedegradation products are water soluble, allowing for the degradationproducts to be eliminated from the human body as waste products.

BACKGROUND OF THE INVENTION

Generally, the key requirements of a tissue adhesive are:

-   -   (1) In use, the adhesive must mimic the mechanical performance        of the undamaged tissue;    -   (2) The adhesive should provide sufficient tack for “primary”        fixation with the opportunity for manipulation and re-alignment        prior to setting strongly;    -   (3) Any exothermic process involved in the curing of the        adhesive should not damage the surrounding tissue;    -   (4) The adhesive must not elicit any toxic response by the        surrounding healthy tissue and should facilitate the re-growth        of new tissue where possible;    -   (5) The adhesive should not liberate harmful degradation        products;    -   (6) The adhesive should degrade, and as it does so, it should be        replaced by new tissue with minimal scarring; and    -   (7) Any biodegradation products should not accumulate in the        body but should be eliminated naturally either by excretion or        incorporation into the natural biochemical cycle.        [“Polymeric Biomaterials”, 2^(nd) Ed., Marcel Dekker        Inc., (2002) pp. 716]

It is well known in the art that diisocyanate monomers may be used toform polymeric adhesives. However, many of the diisocyanate monomersthat are commercially available are small molecule diisocyanate monomersthat present toxicity and sensitization hazards and that polymerize toform products having toxic degradation products, for instance, aromaticamines. As such, commercially available small molecule diisocyanatemonomers are unsuitable for human use as an internal adhesive orsealant.

Metabolically acceptable polyisocyanate monomers are described in U.S.Pat. No. 4,829,099. More specifically, this reference describes anaromatic benzoyl isocyanate terminated monomer, having glycolic acidresidues and polyethyleneglycol residues, in formula “I, Preferred”.This reference indicates that the resultant polymer will degradeultimately to metabolically acceptable products, includingp-aminobenzoic acid, polyethylene glycol and glycolic acid. Although theresultant polymer in principal could degrade into the aforementionedcompounds, it is believed that only the glycolic acid residues wouldhydrolyse in vivo, resulting in a mixture of water-soluble and waterinsoluble fragments. The water-soluble fragments would be eliminatednaturally by excretion from the body. However, the water insolublefragments would not be eliminated naturally, resulting in theundesirable accumulation of the water insoluble fragments in the body.

Polyester-urethane-urea block copolymers prepared from commerciallyavailable small molecular diisocyanates, i.e. tolylene diisocyanate(TDI), diphenylmethane-4,4′-diisocyanate (MDI), and hexamethylenedisisocyanate (HMDI), are described in U.S. Pat. No. 6,210,441. However,these copolymers would be unsuitable for use as a surgical adhesive orsealant, since the copolymers are already polymerized, i.e., alreadycured, and would not provide sufficient opportunity for manipulation andre-alignment. Moreover, such copolymers are not believed to mimic themechanical performance of undamaged tissue.

Therefore, it is desirable to have a monomer based internal adhesive orsealant formulation that is capable of polymerizing in vivo to form aninternal adhesive or sealant, in order to provide an opportunity formanipulation and re-alignment. Specifically, it is desirable that theadhesive or sealant formulation fill internal cavities and voids,penetrating and conforming to the interstices and pores of the tissue,prior to curing or setting.

Additionally, it is desirable to have a monomer based internal adhesiveor sealant formulation that polymerizes in vivo, where the monomer, theformulation thereof, and the resultant polymer are biocompatible. Theresultant polymer should also be biodegradable.

Finally, it is desirable that the degradation products of the resultantpolymer be both biocompatible and water soluble, so that the degradationproducts are completely eliminated from the human body as wasteproducts.

SUMMARY OF THE INVENTION

Novel macromers or a mixture thereof are described herein, comprisingbenzoyl isocyanate terminal moieties and at least two residues of awater-soluble polymer having a molecular weight ranging from 80 to10,000 adjacent to the carbonyl group of the benzoyl isocyanatemoieties, thereby forming at least two ester linkages in the macromer.

Definitions

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as is commonly understood by one of skill in theart to which this invention belongs. All patents and publicationsmentioned herein are incorporated by reference.

“Biocompatible” as used herein refers to a material that, onceimplanted, does not interfere significantly with wound healing and/ortissue regeneration, and does not cause any significant metabolicdisturbance.

“Biodegradable” and “bioabsorbable” as used herein refer to a materialthat is broken down spontaneously and/or by the mammalian body intocomponents which are consumed or eliminated in such a manner as not tointerfere significantly with wound healing and/or tissue regeneration,and without causing any significant metabolic disturbance.

“Water-soluble polymer” as used herein refers to a polymer, whichdissolves in water, forming transparent solutions under ambientconditions (e.g. body temperature).

“Polyisocyanate” as used herein refers to a compound with two or moreisocyanate groups.

“Urethane linkage” as used herein refers to a residue derived from aurethane moiety and having a carbonyl-containing functional group inwhich the carbonyl carbon is bound both to an ether oxygen and to anamine nitrogen:

[“Organic Chemistry”, J. McMurry, 2^(nd) ed., Brooks/Cole PublishingCompany, (1988), pp 1129].

“Urea linkage” as used herein refers to a residue derived from a moietyhaving a carbonyl-containing functional group in which the carbonylcarbon is bound to identical units of amine nitrogen:

[“Nomenclature of Organic Chemistry”, Pergamon Press, Oxford, (1979)].

DETAILED DESCRIPTION OF THE INVENTION

As described above, a monomer based internal adhesive or sealantformulation that is capable of polymerizing in vivo to form an internaladhesive or sealant, should wet the tissue to which it is applied,penetrating and conforming to the interstices and pores of the tissue,prior to curing or setting. Additionally, the monomer, the formulationthereof, and the resultant polymer should be biocompatible.

The monomer and the formulation thereof described herein are suitablefor internal applications, since neither the monomer, the formulationthereof nor the resultant polymer metabolizes in the human body to formtoxic products.

Additionally, the monomer and the formulation thereof polymerize to forma biocompatible polymer upon contact with water or body fluids. Thebiocompatible polymer then degrades in vivo to form degradation productsthat are both biocompatible and water soluble, which are then eliminatedfrom the human body as waste products.

The monomer and the formulation thereof have multiple medicalapplications and may be used in many types of surgery, including, butnot limited to, cardiovascular, peripheral-vascular, cardio-thoracic,gynecological, neuro- and general abdominal surgery.

For example, the monomer and the formulation thereof may be used as aninternal surgical adhesive in orthopedic procedures such as anteriorcruciate ligament repair, meniscal tear repair (or as a hydrogel for thereplacement of the meniscus), posterior capsule reconstruction, rotatorcuff repair, and as a bone adhesive. It could also be used as anadhesive for lung volume reduction, patch fixation, subcutaneous tissuerepair, and aortic dissection. In particular, it can be used as stomachadhesive for stomach volume reduction, and as adhesive for mesh fixationfor hernia repair, drain fixation, valve attachment, attachmerit foradhesion prevention films, attachment of tissue to tissue (e.g.synthetic or biologic tissue scaffold to tissue, bioengineered tissue totissue), tissue to device (e.g. mesh, clip, film) and device to device.

Second, the monomer and the formulation thereof may be used forsubcutaneous tissue repair and for seroma prevention in procedures suchas mastectomy, breast reconstruction & augmentation, reconstructive orcosmetic abdominoplasty and liposuction, face lift, C-section,hysterectomy in obese patients, orthopedic on thigh region, incisionalhernia repair, lipoma excision, traumatic lesions, fistula treatment,graft fixation, and nerve repair.

Third, the monomer and the formulation thereof may be used as a sealantto attach and seal dural patch products, bile duct, bile leaks in liverbed, bladder leaks, bone graft, burn graft dressing and liquid occlusivedressing. As a sealant, it can be coated on tissue, device, andtissue-device interface and it can be used as dural—cranial sealant,dural—spine sealant, cardio/peripheral vascular sealant, GI sealant(e.g. esophagus, intestine, large organ, pancreas, stomach, and gastriculcer), lung sealant, soft organ sealant (e.g. liver, spleen, pancreas),bonewax substitute, tumor sealant, staple/glue combination,sealant/hemostats combination, urethra sealant. It can be used inprocedures including, but not limited to, gastric bypass, parenchymatousorgans resection, tracheostomy, ulcerative colitis diverticulosis,radical prostatectomy, sinus reconstruction, sternotomy,choledochoduodenostomy, and gallbladder (liver) bed sealing, andcholecystectomy.

Fourth, the monomer and the formulation thereof may be used as a filleror a periurethral bulking agent in procedures including, but notlimited, to dead space removal in reconstructive and cosmetic surgeries,(e.g. plastic/cosmetic/reconstructive, face/facial defect, or voidfilling), urinary incontinence and other gynecologic procedures, analfissure/fistula, catheter injection into myocardium for treatingcongestive heart failure, nuclear augmentation, pancreatic/hepaticcyst/fistula obliteration, and pediatric esophogeal fistula.

Fifth, the monomer and the formulation thereof may be used as a matrixfor tissue engineering (e.g. tissue scaffolds, delivery matrix forcells, delivery matrix for brachytherapy (radiation therapy) agents,delivery matrix for growth factors, injection matrix for in situ-formingempty cell scaffold, injection matrix for scaffold for delivery of stemcells, cell lysate, or other biologics, bioactives, pharmaceuticals, andneutraceuticals, localization matrix for chemotherapy, and localizationmatrix for contrast agent.

Sixth, the monomer and the formulation thereof may be used as anadhesion prevention barrier in procedures such as cardiac, open chest,general surgery, obstetrics and gynecological surgeries, orthopedicsurgeries, and spine (e.g. artifical disk).

Seventh, the monomer and the formulation thereof may be used as anoccluding material for embolization (e.g. GI Fistula, cerebral/vascularocclusive brain aneurism, tubal occlusion, and varicose vein occlusion).

Macromer

The monomer described herein is a biocompatible polyisocyanate macromer,terminating with benzoyl isocyanate groups and having the structuralformula I:

where R₁ is an organic residue containing a urethane linkage that isattached to R₂ when the value of “a” is one or more, and preferably oneto five. The value of “a” in formula I may also be zero.

The macromer may also be a polyisocyanate macromer represented byformula II:

Wherein f represent the number of end-groups in the macromer.

When f=2, formula II represents a linear macromer, when f is three ormore, formula II represents a branched macromer.

An example of R₁ when “a” is one or more is shown below:

where the ethylene oxide portion of R₁ may be linear or branched, and cmay range from 1 to 100, and preferably from 1 to 10.

The general structure of R₂ in formula I is the following:—R₃—R₄—R₃—  (R₂)Where R2 in formula I has hydrolysable ester linkages that arebiodegradable in vivo; R3 may be residue of a water soluble polymer,including but not limited to a residue of a polyalkylene glycol such aspolyethylene glycol, a polyalkylene oxide, polyvinylpyrolidone,poly(vinyl alcohol), poly(vinyl methyl ether), polyhydroxymethylmethacrylate, a polyacrylic acid polymer and copolymer, polyoxazoline,polyphosphazine, polyacrylamide, a polypeptide, or the water-solublederivatives of any of the above, that is capable of forming esterlinkages together with R4, and (i) ester linkages together with thecarbonyl group of the benzoyl isocyanate moiety when “a” is zero or (ii)urethane linkages together with R1 when “a” is one or more. Further, R3may be linear or branched. When R3 is a polyethylene glycol residue,

CH₂—CH₂—O

_(n)and “a” is one or more, n should be sufficiently large to render thedegradation product IV (shown below) water soluble. For example, n mayrange from 2 to 250, preferably from 5 to 100, and more preferably is 5to 25. The molecular weight of R3 may range from 80 to 10,000,preferably 200 to 4000, and more preferably 200 to 1000. These residuesof water- soluble polymer must be coupled into the macromer in the R3position and are critical to the solubility of the degradation products,as will be discussed in more detail below.

R4 may be an organic residue capable of having carboxylate end-groups.For example, R4 may be derived from linear diacids, such as diglycolicacid, malonic acid, glutaric acid, succinic acid, adipic acid, orcarboxylic acid terminated-polyalkyleneglycols such as polyalkyleneglycol dicarboxylates.

If R4 is an aliphatic dicarboxylate:

m may range from 1 to 10. The selection of m is based on two factors:biocompatibility and solubility of degradation products. If m is 0, thediacid hydrolytic degradation product of the macromer is too acidic,thus detrimental to biocompatibility of the composition. If m is toolarge, the diacid degradation product will no longer be water soluble.

Alternatively, R4 may be derived from a branched acid such astricarballylic acid, citric acid, or tartaric acid or the glutaricanhydride derivative thereof. Alternately, R4 may be derived from any ofthe aforementioned acids, carboxylic acid terminated-polyalkyleneglycolsor glutaric andhydride derivative, resulting in a compound withcarboxylate end-groups. Additional examples of R4 are shown below:

Alternately, R2 may be formed from any carbonyl-containing moiety viasynthetic routes (including but not limited to trans-esterification,acid halide-alcohol condensation, acid-alcohol condensation) resultingin ester linkages to R3.

Examples of R2 includes but is not limited to a residue of a PEG-estermade from the polycondensation reaction of polyethylene glycol and acompound bearing multiple carboxylic groups, wherein the carboxylicgroup containing compounds include but are not limited to diglycolicacid, malonic acid, succinic acid, glutaric acid, adipic acid, tartaricacid, and carboxylic acid terminated-polyalkyleneglycols.

Examples of a PEG-ester version of R₂ residue include but are notlimited to:

-   -   where n is 20 for PEG of Mw 900 and the diacid is diglycolic        acid    -   where n is 20 for PEG of Mw 900 and the diacid is succinic acid    -   where n is 20 for PEG of Mw 900 and the diacid is glutaric acid    -   where n is 20 for PEG of Mw 900 and the diacid is adipic acid

Other examples include branched R₂ residues are shown below and in FIG.1:

The molecular weight of the R₂ residue portion of the macromer may rangefrom about 80 to 20,000 g/mol.

Producing a polyester polyol from which R₂ may be derived in high yieldrequires the use of a transition metal catalyst such as tin (II). Tinsalts are well known as catalysts for esterification. They arehydrolytically stable and can withstand moisture generated duringesterification without any loss of activity. They are more desirable touse than acid catalysts such as p-toluenesulfonic acid or mineral acidsbecause these materials promote ether cleavage as well as oxidiation,especially at higher temperatures. Typical temperatures duringesterification of the polyols and polyacids range from 160-220° C. It isdesirable to obtain a polyester polyol that contains as little oxidationside products as possible as this will affect the performance of themacromer. Tin catalysts also significantly reduce reaction times.Typical times to reach the desired polymer molecular weight and acidcontent range from 12-18 hours. To achieve a similar product withoutcatalyst would require more than 60 hours. However, tin metal is toxicand must be removed from the polyol once esterification is complete.

Removing the tin catalyst after the reaction is completed poses a uniqueproblem because regular methods to remove the catalyst are not aseffective in polyester polyols. A common method is to use a small amountof hydrogen peroxide to oxidize the tin to an insoluble tin oxide, whichcan be filtered off. This is undesirable as treating any polyethyleneglycol containing material with a peroxide will accelerate the formationof carbonyl and peroxide groups, which are undesirable impurities.Washing the material with water does not work either because thematerial itself is hydrophilic and tin is not easily hydrated. Adding amineral acid to neutralize the tin is undesirable, as it will alsohydrolyze eater bonds in the polymer. It is therefore desirable to finda mild adsorption agent that will selectively remove tin.

Citric acid can be used to chelate the tin catalyst, followed bytreatment with silica to adsorb the tin citrate complex. Preferably amixture of citric acid and silica is used. More preferably, a silicahydrogel treated with citric acid sold under the trademark Sorbsil R® byIneos Silicas is used in the edible oils industry to remove trace metalsand other polar impurities. The material is described as a silicahydrogel that is treated with citric acid. Citric acid is a knownchelating agent and when covalently bound to silica, it increases theeffectiveness of chelating metals such as tin compounds that are not aseasily hydrated. Additionally, the polyester polyols have a highaffinity for the tin catalyst since concentrations as high as 700 ppm oftin in the polymer are clear and free of sediment, which is not typical.Quantities from 0.01-1.00% by weight of oil can be used to effectivelyremove undesired impurities in the oil. This silica/citric acid mixtureis suitable for removal of tin II & IV, both of which are commoncatalysts used in esterification. By treating a crude tin catalyzedpolyester polyol with silica/citric acid, the tin can be adsorbed andfiltered off leaving the metal free polyol. An organic solvent, such astoluene is necessary to aid in filtration because the silica/citricacid/tin complex is partially soluble in the polyester polyol. Since thesilica/citric acid mixture is hydrophilic, it is necessary to add ahydrophobic solvent that will solublize the polyester polyol andprecipitate the silica-citric acid hydrogel. The hydrophobic solventsinclude, but not limited to, benzene, toluene, xylene, methylenechloride and chloroform. Addition of the solvent precipitates thecomplex facilitating filtration. Other materials, such as carbon powderand diatomaceous earth can be added during treatment to improve colorand filtration times. Use of this method of tin removal results in apolyester polyol free of tin with no significant increase in acidcontent, which is a sign of hydrolysis. Typical polymers worked up inthis manner have contained less than 5 ppm of tin (600 ppm tin beforetreatment), ˜99.5% conversion of acid groups to ester groups (˜99.8%conversion before treatment) and no significant evidence of carbonylgroups when analyzed by proton NMR.

For instance, a crude polyester polyol is treated with 1-10% by weightof a silicate, 0.05-1.00% by weight of carbon and 0-1% by weight ofdiatomaceous earth. The slurry is stirred for 30-90 minutes under aninert atmosphere at 60-85° C. The polymer is diluted to 40-60% by weightusing a suitable organic solvent then filtered. The solvent isevaporated to yield the desired polyester polyol with low tin.

Examples of linear macromers include those shown in Formulae Ia and Ib.

An example of a preferred macromer for a surgical sealant applicationgiving high intestinal burst strength is shown in FIG. 2 as Ic. Apreferred macromer composition is a mixture of macromers Ic and Id (asshown in FIG. 3) in a 1:1 molar ratio.

An example of a branched macromer is IIa:

A preferred branched macromer for intestinal burst strength is shown inFIG. 4 as IIb.

An alternative type of branched macromer is shown below as III. Theseare prepared by coupling an excess of linear isocyanate-terminatedmacromers of formula I with a multifunctional active hydrogen-terminatedcompound, such as a hydroxy-terminated compound, as shown here in R₆:

Wherein the intermediate polyol has g+1 hydroxyl end groups.

The molecular weight and degree of branching of the macromer are animportant factors for determining biomechanical properties, such aselasticity, adhesive and cohesive strength, viscosity, absorption andwater-uptake (swelling). TABLE 1 Desirable Property Ranges for IntendedUse of the Composition Preferred Preferred Range for Range for PropertyRange Sealant Adhesive elasticity¹ 10-2000% 50-500% 10-50% adhesivestrength² burst pressure: >200 mmHg lap shear tensile >200 mmHgstrength >1 Mpa cohesive strength³ 0.1-30 Mpa 0.1-5 Mpa 5-25 Mpa²Adhesive strength quantifies the ability of the adhesive/sealantmaterial to adhere to the biological tissue. It is measured by the fluidburst pressure test-ASTM 2392-04 - Burst pressure testing is performedby cutting a linear incision of 0.5 cm in a substrate (pericardium, duraor collagen) and placing the substrate in a test fixture.# Sealant is applied to the incision and allowed to cure. Increasingpressure is applied to the transverse side of the substrate using asyringe pump filled with fluid. The maximum pressure is recorded whenthe sealant ruptures.^(1,3)Cohesive strength refers to the intrinsic ability ofadhesive/sealant material to withstand tensile forces. Cohesive strengthand elasticity are measured by Elongation and Modulus - Tensilespecimens of cured sealant are prepared by casting as a film. Thesamples are tested in tension at 1 inch/minute until failure.# The maximum load and elongation at failure are recorded.

The range of the molecular weight of the macromers described herein maybe between about 500 to 20,000 g/mol, and preferably between about 500and about 4000 g/mol.

Macromer-Containing Formulation:

A medically acceptable formulation may comprise the polyisocyanatemacromer, a solvent, a catalyst, a surfactant, a stabilizer orantioxidant, and a color additive.

Typically, the solvent is a hydrophilic solvent, including but notlimited to dimethyl sulfoxide (DMSO), acetone, dimethoxy PEGs,glycerine, Tween 80, dimethylisosorbide, propylene carbonate, and1-methyl-2-pyrrolidinone (NMP). Less hydrophilic solvents may also beconsidered, such as: ethyl lactate, triacetin, benzyl alcohol,benzylbenzoate, various ester solvents, such as: triethyl citrate,acetyltriethyl citrate, tri-n-butyl citrate, acetyltri-n-butyl citrate,ethyl acetate and the like. For example, the solvent may be used in anamount up to about 50 weight % based on the total weight of solvent andmacromer.

The solvent plays several roles in the macromer formulation: (1)viscosity control, (2) control of bubble/foam formation and bubbleescape, (3) to enhance tissue penetration, and (4) to provide improvedtissue wetting. The viscosity of the formulation ranges from 10 to100,000 cp, preferably from 500 to 50,000 cp.

Surfactants may also be added to the formulation to control foaming:non-ionic surfactants such as Tween, Brij and siloxanes, as well asionic surfactants, such as lecithin (phosphatidyl choline), sodiumdodecyl sulfate, among others known in the arts.

Catalysts may also be added to the formulation for to increase reactionspeed, such as triethylene diamine (DABCO), pyridine, ethyl-2-pyridylacetate, and stannous octoate.

The color additive that may be utilized in the macromer formulationincludes, but is not limited to, methylene blue, FD&C Blue #1 or #2, andconventional color additives that are used in absorbable medical devicessuch as sutures.

Antioxidants such as butylated hydroxyl toluene (BHT) may be present inthe macromer formulation to improve shelf stability of the product.

Adhesive System

One example of an adhesive system includes, but is not limited to, asystem where the macromer and a solvent are stored separately untilready for use. For example, the macromer may be stored in one barrel ofa double barrel syringe while the solvent is stored in the other barrel.Alternatively, the macromer and the solvent may be mixed by anyconventionally means prior to use.

Biocompatible Elastic Gel

The resultant polymer after the in vivo polymerization of the macromeris an elastic gel that is biodegradable, and the degradation productsthereof should be both biocompatible and water soluble, so that thedegradation products are completely eliminated from the human body aswaste products.

Specifically, the macromer or formulation thereof polymerizes to form abiocompatible elastic gel upon contact with water or body fluids, viathe following reaction scheme:

wherein X represent the structural component between the two terminalfunctional groups and X depends on the type of macromer utilized. Theabove reaction readily occurs under body conditions resulting in thespontaneuous degradation of the dicarbamate to the diamine and carbondioxide.

In a subsequent reaction, the newly formed diamine reacts with andisocyanate group to form an elastic gel, via the following reactionscheme:

Degradation Products

The elastic gel formed from the macromer described herein isbiodegradable and degrades by hydrolysis in vivo to form degradationproducts, including aromatic degradation products, that are bothbiocompatible and water soluble. In order to insure water solubility ofany aromatic degradation product, the elastic gel is designed to cleavein such a way that the terminal groups on the aromatic degradationproduct are residues of water-soluble polymers. For example, after themacromer adhesive or sealant formulation polymerizes in the body, theelastic gel that results has the following repeat unit:

where R4, as previously described, is a residue capable of havingcarboxylate end-groups and the hydrolysable linkages between R3 and R4,are essential to the hydrolytical biodegradability of the elastic gel.

The biocompatible elastic gel (IV) that is formed comprises varioushydrolysable linkages, including but not limited to, aliphatic andaromatic ester linkages, urethane linkages and urea linkages. Thealiphatic ester linkages in the elastic gel have a higher tendency todegrade in vivo, than the other types of linkages, thereby leaving aninitial aromatic degradation product V. While there are other linkagesin the aromatic degradation product V fragment that are susceptible tohydrolytic degradation (e.g., urethanes, and aromatic esters), for allpractical purposes these do not degrade in vivo to any significantextent before the aromatic degradation product is excreted from thebody. For example, the rapidly hydrolysable aliphatic ester linkagesbetween R3 and R4 in the elastic gel degrade within 0-6 months; the moreslowly hydrolysable aromatic ester linkages in the aromatic degradationproduct degrade within 4-24 months; the urethane linkages in thearomatic degradation product degrade within 4 to 24 months; and the veryslowly hydrolysable urea linkages in the aromatic degradation productdegrade within 24 month to infinity. During the timeframe fromimplantation of the macromer adhesive or sealant formulation toexcretion of the aromatic degradation product V from the body,degradation of the aromatic ester, urethane and urea linkages in thearomatic degradation product V do not occur to any significant extent.

For example let us consider the biodegradation in vivo of a sealant madefrom PEG400-adipic acid PEG-ester converted into a urethane with PEG4-dibenzoyl isocyanate, i.e., structure Ia. After implantation in the body,the elastic gel will initialy degrade hydrolytically into

where all degradation products, including the aromatic degradationproduct, are essentially water soluble. In particular, the aromaticdegradation product is solubilized by the presence of R3, a residue of awater-soluble polymer, as the terminal groups.

This composition has multiple medical applications. For example, as aninternal surgical adhesive, the adhesive can bond tissue to tissue,tissue to medical device and medical device to medical device. As asealant, the composition can be coated on a tissue, or on a medicaldevice, or on the interface of a medical device with tissue to preventleaks. The composition can be used to form films in situ that may haveapplications such as for the prevention of surgical adhesions. Thecomposition can be used to form foams in situ that may have applicationssuch as a filler (e.g. dead space removal, reconstructive and cosmeticsurgeries), bulking agents, tissue engineering (e.g. scaffolds)materials and others where foams and sponges are useful. The compositioncan be formulated so that it is injectable and used to form gels in situthat are localized, and adherent to tissue, staying at the site wherethey are injected. These may have applications such as a delivery matrixfor cells and other biologicals, bioactive agents and pharmaceutical orneutraceutical agents, and as embolization agents, and as means tolocalize contrasting agents. The composition may also be used to attachmedical devices (e.g. meshes, clips and films) to tissues. Thiscomposition can be used internally in many types of surgery, including,but not limited to, cardiovascular, peripheral-vascular,cardio-thoracic, gynecological, neuro- and general abdominal surgery.

As a surgical sealant/adhesive, it can be used as an adjunct to primarywound closure devices, such as staples, sutures, to seal potential leaksof gasses, liquids, or solids. More specifically, the surgicaladhesive/sealant may be applied to a tissue as a part of a surgicalprocedure, in various forms, for example: liquid, powder, film, spongeor foam, impregnated fabric, impregnated sponge or foam, or spray.

As a filler, the macromer or formulation thereof may be used as afacial, defect or void filler. For example, the formulation may beapplied in the interstices of an internal void and allowed to polymerizetherein, such that the polymer fills the internal cavities and voids,penetrating and conforming to the interstices and pores of the tissue.The formulation may be used after a broad number of procedures havingpotential risk of dead space formation, including, but not limited to,radical mastectomy (i.e. breast and regional lymph nodes removal forcancer treatment), breast reconstruction and augmentation procedure,reconstructive or cosmetic abdominoplasty and liposuction, face-lift,cesarean section and hysterectomy in obese patients, orthopedicprocedures on thigh region, incisional hernia repair, lipoma excision,and traumatic lesions, i.e. closed trauma.

While the following examples demonstrate certain embodiments of theinvention, they are not to be interpreted as limiting the scope of theinvention, but rather as contributing to a complete description of theinvention.

EXAMPLES Comparative Prepolymer A1

A polyethylene glycol, Mw 900 g/mol (50 g, 0.056 mol) was dried undervacuum at 120° C. for four hours. Then the polymer was cooled to roomtemperature under nitrogen and glycolide (12.90 g, 0.11 mol) was added.Stannous octoate was added as a catalyst at 1 mol catalyst: 30,000 molglycolide. The mixture was continuously stirred under nitrogen andheated to 150° C. for 3 hours. Next the polymer was cooled to 70° C. andparaphenylene diisocyanate (19.57 g, 0.122 mol) was added. This reactioncontinued under nitrogen with mixing for four hours. The theoreticalstructure of the resulting prepolymer is:

This polymer is a white waxy resin at room temperature.

Example 1 Preparation of Polymers

Prepolymer B1

A 10% solution of ethyl acetate was prepared with 1 mol of tetraethyleneglycol, 2.75 mol of 4-nitro benzoyl chloride, and 6 equivalents ofsodium carbonate. This reaction was carried out with magnetic stirringunder nitrogen at room temperature and atmospheric pressure. Thedi-nitro intermediate:

was next hydrogenated. To the ethyl acetate solution containing thedinitro intermediate palladium catalyst (10% Pd on carbon) was added at5% w/w with vigorous stirring and a hydrogen sparge. This resulted inthe di-amine intermediate:

The diamine was purified by washing with aqueous sodium bicarbonate andbrine, followed by drying over anhydrous magnesium sulfate. This diaminepowder was then dried at 50° C. under vacuum for 12 hours. The purity ofthe diamine was 99.1% by HPLC.

To prepare the diisocyanate the following procedure was used. In a oneliter, three neck flask 68.62 g (0.231 mol) triphosgene and 375 mL ofethyleneglycol diacetate were mixed under nitrogen atmosphere. Theresulting suspension was stirred for 20 minutes at ambient temperatures(23° C.). A suspension of 100.0 g (0.231 mol) of PEG-bz-NH₂ (diaminefrom above) in 333 ml of ethylenglycol diacetate was added within 30minutes at ambient temperatures (23° C.) to the triphosgene suspension.A thin, slightly yellowish suspension was obtained. The reaction mixturewas then heated in the following sequence: to 50° C. (resulting in apink suspension), then 5 minutes later to 70° C., then 40 minutes laterto 90° C. (resulting in a clear solution), then 25 minutes later to 100°C., then 30 minutes later to 115° C., finally, 1 hour later to 130° C.At 130° C. the reaction was stirred for 3 hours and then cooledovernight to ambient temperatures. The following morning the obtainedbrownish solution was distilled. Distillation started at 94.5° C.(pressure: approximately 1 mbar). After the distillation was finishedthe temperature of the oil bath was increased to 130° C. to removeresidual solvent from the reaction mixture. Yield: 112.5 g, purity94.7%, 1.1% of residual solvent.

Optionally, as a reaction solvent, instead of ethyeneglycol diacetate,glycerol triacetate (triacetin) was found to yield a product with puritygreater than 95%. However, other common solvents, such as toluene,acetone, ethyl acetate, dichloromethane, glyme, 1,4-dioxane, propylenecarbonate and acetonitrile, resulted in much lower product purity. Also,conducting the reaction without solvent, results in low product purity.

The resulting product is:

The structure was confirmed by NMR and % NCO titration. The purity wasconfirmed by performing HPLC on dibutylamine-blocked product. Theproduct is an amber viscous liquid at room temperature.

Prepolymer B2

Polyethyelene glycol, Mw 900 g/mol (0.2 mol) was added to adipic acid(0.1 mol) with polymer bound para-toluene sulfonic acid, at 0.01 mol %.The mixture was heated to 160° C. and water was condensed and distilledwith the assistance of a nitrogen purge. Next a vacuum was applied forthree hours. The resulting polyol:

is a clear, colorless low viscosity liquid.Prepolymer B3

Two mol of prepolymer B1 are added to 1 mol of prepolymer B2 and weremixed and heated to 70° C. for 8 hours under nitrogen. The resultingpolymer, a viscous amber liquid at room temperature, is shown in FIG. 5.

Example 2 Preparation of Polymers

Polyester Polyol for Macromer Id

To a clean, dry 250 mL 3 neck flask fitted with nitrogen inlet,temperature probe and dean-stark trap was charged 8.72 g (0.0947 moles)of Glycerin USP. The contents were heated to 120° C. with stirring undernitrogen. Upon reaching temperature, vacuum was applied for 2 hours.Vacuum was released and 32.46 g (0.2845 moles) of Glutaric Anhydride wasadded. The solution was stirred under nitrogen at 120° C. for 2 hoursuntil IR showed no anhydride present. The solution was cooled and 167.09g (0.2784 moles) of PEG 600 NF and 0.20 g (0.0009 moles) of Tin (II)Oxalate were added. The flask was heated to 180° C. and held for 2 hoursunder nitrogen sparge. Vacuum was applied for an additional 17 hoursafter which the conversion of acid to ester groups was 99.98% based onthe acid content. The polyol was cooled to 80° C. and the following wereadded; 6.13 g of silica-citric acid and 2.38 g of diatomaceous earth.The slurry was stirred at 80° C. under nitrogen blanket for 1 hour. Theslurry was diluted to 50% w/v in toluene and stirred for another 15minutes and filtered through 2-micron cellulose paper. The solvent wasevaporated to leave a pale yellow, viscous liquid. Yield=91%, esterconversion=99.73%, Tin content=less than 5 ppm.

Macromer Id

To a clean, oven dried 1 neck 25 mL flask was charged 2.01 g (0.0009moles) of the Polyester Polyol described in example 2. The polyol wasdried under vacuum on a 120° C. oil bath with stirring for 6 hours. Thedried polyol was cooled and 2.28 g (0.0047 moles) of Prepolymer B1 fromexample 1 was added under a nitrogen atmosphere. The mixture was stirredfor 20 hours under nitrogen at 70° C. The prepolymer was cooled anddiluted to 80% solids in Acetone to yield a viscous amber liquid with aviscosity of ˜8,000 cst (25° C.).

Example 3 Preparation of Polymers

Polyester Polyol for Macromer Ic

To a clean, dry 1 L 4-neck flask fitted with mechanical stirrer,nitrogen inlet, temperature probe and dean-stark trap was charged 149.79g (0.3744 moles) of PEG 400 NF. The contents were heated to 120° C. withstirring under nitrogen. Upon reaching temperature, vacuum was appliedfor 1.5 hours. Vacuum was released and 85.56 g (0.7499 moles) ofGlutaric Anhydride was added. The solution was stirred under nitrogen at120° C. for 2.5 hours until IR showed no anhydride present. The solutionwas cooled and 436.06 g (0.7268 moles) of PEG 600 NF and 0.67 g (0.0032moles) of Tin (II) Oxalate were added. The flask was heated to 180° C.and held for 2 hours under nitrogen sparge. Vacuum was applied for anadditional 16 hours after which the conversion of acid to ester groupswas 99.96% based on the acid content. The polyol was cooled to 80° C.and the following were added; 6.97 g of silica-citric acid, 7.11 g ofdiatomaceous earth and 3.39 g of activated carbon. The slurry wasstirred at 80° C. under nitrogen blanket for 1 hour. The slurry wasdiluted to 50% w/v in toluene and stirred for another 15 minutes andfiltered through 2-micron cellulose paper. The solvent was evaporated toleave a pale yellow, viscous liquid. Yield=95%, ester conversion=99.88%, Tin content=less than 5 ppm.

Macromer Mixture of Ic:Id in a 1:1 Ratio

To a clean, oven dried 2 neck 250 mL flask fitted with a mechanicalstirrer was charged 28.18 g (0.0154 moles) of the Polyester Polyoldescribed in example 3 and 33.90 g (0.0152 moles) of the PolyesterPolyol described in example 2. The polyol mix was dried under vacuum ona 120° C. oil bath with stirring for 8 hours. The dried polyol wascooled and 59.38 g (0.0.1224 moles) of Prepolymer B1 from example 1 wasadded under a nitrogen atmosphere. The mixture was stirred for 20 hoursunder nitrogen at 70° C. The prepolymer was cooled and diluted to 80%solids in Acetone to yield a viscous amber liquid with a viscosity of˜4,000 cst (25° C.).

Example 4 Preparation of Polymers

Polyester Polyol for Macromer IIb

To a clean, dry 250 mL 3 neck flask fitted with nitrogen inlet,temperature probe and dean-stark trap was charged 53.88 g (0.0842 moles)of Glycerol Ethoxylate M_(n)=1000. The contents were heated to 120° C.with stirring under nitrogen. Upon reaching temperature, vacuum wasapplied for 2 hours. Vacuum was released and 19.67 g (0.1724 moles) ofGlutaric Anhydride was added. The solution was stirred under nitrogen at120° C. for 3 hours until IR showed no anhydride present. The solutionwas cooled and 86.99 g (0.0.1449 moles) of PEG 600 NF and 0.20 g (0.0009moles) of Tin (II) Oxalate were added. The flask was heated to 180° C.and held for 2 hours under nitrogen sparge. Vacuum was applied for anadditional 20 hours after which the conversion of acid to ester groupswas 99.30% based on the acid content. The polyol was cooled to 80° C.and the following were added; 6.13 g of silica-citric acid and 2.11 g ofdiatomaceous earth. The slurry was stirred at 80° C. under nitrogenblanket for 1 hour. The slurry was diluted to 50% w/v in toluene andstirred for another 15 minutes and filtered through 2-micron cellulosepaper. The solvent was evaporated to leave a pale yellow, viscousliquid. Yield=95%, ester conversion=99.12%, Tin content=less than 5 ppm.

Macromer IIb

To a clean, oven dried 1 neck 50 mL flask was charged 7.03 g (0.0022moles) of the Polyester Polyol described in example 4. The polyol wasdried under vacuum on a 120° C. oil bath with stirring for 6 hours. Thedried polyol was cooled and 5.58 g (0.0.0115 moles) of Prepolymer B1from example 1 was added under a nitrogen atmosphere. The mixture wasstirred for 20 hours under nitrogen at 70° C. The prepolymer was cooledand diluted to 80% solids in Acetone to yield a viscous amber liquidwith a viscosity of ˜15,000 cst (25° C.)

Example 5 Degradation Studies

The test polymer was cast onto glass and allowed to moisture cure underambient humidity for several hours until a rubbery film was formed. Thefilm was then subjected to the following accelerated hydrolysisconditions. The method consists of hydrolytically degrading a testspecimen while maintaining a constant pH by titrating with a standardbase and measuring the quantity of base used with time. This measurementand titration is automated by a pH stat instrument (718 STAT TitratorComplete, by MetroOhm, using Software TiNet 2.4). Samples are placed ina 70 mL stirred, sealed, bath of deionized water held at 75° C.+/−0.2°C., and at pH 7.27. Each sample bath is continuously monitored for pHchanges (drops in pH) from the set point of 7.27. If any decrease ismeasured, sodium hydroxide solution is added to return to 7.27 (NaOH0.05N). The hydrolysis continues until the titrating base is no longerneeded to maintain the pH at 7.27. Any undissolved residue is collected,dried and weighed. The mass remaining is reported. TABLE 2 DegradationStudies of Selected Macromers (Mass remaining of degraded polymer.Degraded at 75° C., pH stat 7.27, for 10 days). Composition Wt. %remaining at end Comparative A1 30 Inventive B3 0.5

Table 2 indicates that the water-solubility of the degradation productfrom the inventive composition B3 is far greater than that of thecomparative composition of A1.

Example 6

Burst pressure testing is performed by cutting a linear incision of 0.5cm in a substrate (pericardium, dura or collagen) and placing thesubstrate in a test fixture. Sealant is applied to the incision andallowed to cure. Increasing pressure is applied to the transverse sideof the substrate using a syringe pump filled with fluid. The maximumpressure is recorded when the sealant ruptures. TABLE 3 Intestinal BurstPressure of Selected Macromers Ic and Id in a Macromer Ic 1:1 ratio IIbBurst mm Hg 28 36 63

1. A polyisocyanate macromer or mixture of macromers of the formula:

wherein f is two or more; “a” is zero or one; and when “a” is one to five, R₁ is

where the ethylene oxide portion of R₁ may be linear or branched, and c may range from 1 to 100; R₂ is —R₃—R₄—R₃—  (R₂) where R3 is a linear or branched residue of a water soluble polymer that is capable of forming ester linkages to R4, and (i) ester linkages together with the carbonyl group of the benzoyl isocyanate moiety when “a” is zero, or (ii) urethane linkages to R1 when “a” is one or more; and R4 is a linear or branched organic residue capable of having two or more carboxylate end-groups.
 2. The macromer or mixture of macromers of claim 1, where f is two, and the marcomer is represented by the formula:


3. The macromer of claim 1, where R2 is selected from the group consisting of

where n is from 2 to 250 and m is from 1 to
 10. 4. The macromer or mixture of macromers of claim 1, where R3 is a residue of a compound selected from the group consisting of a polyalkylene glycol, a polyalkylene oxide, polyvinylpyrolidone, poly(vinyl alcohol), poly(vinyl methyl ether), polyhydroxymethyl methacrylate, a polyacrylic acid polymer and copolymer, polyoxazoline, polyphosphazine, polyacrylamide, a polypeptide, and water soluble derivative thereof; and R4 is a residue of a compound selected from the group consisting of diglycolic acid, malonic acid, succinic acid, glutaric acid, adipic acid, tartaric acid, citric acid, tricarballylic acid, glycerol triglutarate, pentaerithritol tetra glutarate, and erithritol.
 5. A biocompatible polymer comprising the repeat unit:

where R3 is a linear or branched residue of a water soluble polymer that is capable of forming ester linkages with R4 and urethane linkages; and R4 is an organic residue capable of having carboxylate end-groups.
 6. A medically acceptable formulation comprising the macromer or mixture thereof of claim 1 and at least one solvent.
 7. An adhesive system comprising: a first housing comprising a solvent; and a second housing comprising the macromer or mixture of macromers of claim
 1. 8. A method for sealing an internal wound comprising the steps of mixing the macromer or mixture of macromers of claim 1, or a composition comprising said macromer or mixture, with a solvent to obtain an adhesive composition; applying the adhesive composition to a wound; and allowing the adhesive composition to form an elastic gel.
 9. The method for sealing an internal wound according to claim 8, wherein the adhesive composition is injectable via a syringe.
 10. The method for sealing an internal wound according to claim 9, wherein the viscosity of the adhesive composition is from about 500 to 50,000 cP.
 11. A macromer or mixture thereof comprising benzoyl isocyanate terminal moieties and at least two residues of a water-soluble polymer having a molecular weight ranging from 80 to 10,000 adjacent to the carbonyl group of the benzoyl isocyanate moieties, thereby forming at least two ester linkages in the macromer.
 12. The macromer or mixture thereof of claim 11, where said water-soluble polymer is a compound selected from the group consisting of a polyalkylene glycol, a polyalkylene oxide, polyvinylpyrolidone, poly(vinyl alcohol), poly(vinyl methyl ether), polyhydroxymethyl methacrylate, a polyacrylic acid polymer and copolymer, polyoxazoline, polyphosphazine, polyacrylamide, a polypeptide, and water soluble derivatives thereof.
 13. A macromer or mixture thereof of claim 12, where said water-soluble derivatives contain moieties selected from the group consisting of amide, urea and urethane. 